Overview of Global Polio Eradication Initiatives: Progress in Afghanistan After the Political Change

 Dr. Sabawoon’s presentation at Waseda University

by Connor Bender

On August 10th, 2023, Dr. Kazuhisa Takemura, a Professor in the Department of Psychology and Director of the Center for Decision-Making Research at Waseda University, invited Dr. Wrishmeen Sabawoon to present about Global Polio Eradication Initiatives (GPEI) to his students. The presentation’s aim was to inform the students about the current state of polio in the world and spread awareness about the methods that are being taken to fully eradicate the disease. Around 30 students attended the presentation.

Dr. Sabawoon started by introducing everyone to the monumental effort known as the Global Polio Eradication Initiative (GPEI), which stands as one of the largest public health interventions in history. With billions of dollars invested into it from countries, organizations, and companies around the world, this initiative aims to completely eradicate polio, a highly infectious viral disease that primarily affects children and can lead to paralysis in severe cases. When the GPEI was first launched in 1988, polio was present in almost 125 countries, but as of this date, the incidence of polio has decreased by 99 percent and only Afghanistan and Pakistan remain endemic countries. Within these two countries, the poliovirus circulates in small geographic areas.  Afghanistan, which was the country where Dr. Sabawoon was born and remained until his early 30’s, was the focus of the presentation. He informed the students that he once played a vital role as part of the Polio High Council in Afghanistan, a ministerial forum to support the polio eradication program, and now works to eradicate polio by collaborating with our team at LIAISON and governmental diet members in Japan, illustrating the global nature of this endeavor.

Dr. Sabawoon then went on to describe polio itself, a disease with a history dating all the way back to ancient Egypt. He highlighted the types of polioviruses (3 types, with only type 1 still present on the planet), transmission modes (both fecal-oral and oral-oral), and the spectrum of infection outcomes. He also delved into the vaccine production process, discussing the Inactivated Polio Vaccine (IPV), which contains inactivated and killed poliovirus strains, and the Oral Polio Vaccine (OPV), which contains live but weakened poliovirus strains, and how both played pivotal roles in curbing the disease's spread. He explained vaccine-derived poliovirus, especially circulating vaccine-derived poliovirus (cVDPV), which is a rare adverse effect of OPV. cVDPV outbreaks in Africa and the Eastern Mediterranean region are a new challenge for the polio program now.  He explained that widespread vaccination is the key solution for eradication, underscored by the fact that only by vaccinating the entire target under-five years population can both wild and vaccine-derived polioviruses be eradicated on a global scale.

Dr. Sabawoon then rounded out the presentation by talking about the current global situation, where the number of polio cases has dwindled significantly. The lecture emphasized the GPEI strategy spanning from 2022 to 2026, aimed at eradicating polio within this time frame. The strategy requires US$ 4.6 billion of which only US$ 2.6 has been secured. He added that the GPEI Oversight Board has requested the Government of Japan to pledge US$ 125 million for the strategy. Afghanistan's socio-political landscape, resource wealth, and recent changes in governance were also explored, with Dr. Sabawoon noting that after the Taliban returned to power in 2021, there have been promising developments in security, resource extraction, and drug control/ rehabilitation. Despite these positive changes, challenges remain, including addressing gender-based restrictions and ensuring continuous support for the health system and immunization programs. He added that the main challenge to GPEI was inaccessibility to reach children in polio campaigns due to conflict conditions and security threats. Millions of children were inaccessible in each round of the polio campaign. After the political change, the Taliban administration conducted successful polio campaigns in the entire country. Access to children is not a challenge in the polio campaign as of this date, and polio workers vaccinated around 3.5 million more children in national-level campaigns than during war times. The plea for Japan's financial support to bolster Afghanistan's polio eradication strategy was a crucial takeaway, aligning with the lecture's overarching message of collaboration and commitment to rid the world of polio once and for all. At the very end of his presentation, Dr. Sabawoon responded to the questions of students, researchers, and a professor.

At LIAISON, we will continue working with our partners toward global polio eradication.